The broad, long-term goal of this project is to decrease colorectal cancer (CRC) mortality through encouraging informed decision making about routine CRC screening (CRCS). National data indicate that current rates of CRC screening do not approach Health People 2010 targets. There is evidence that low health literacy adversely impacts access to care and receipt of preventive health care services including cancer screening. This exploratory/developmental research grant (R21), titled "Promoting Health Literacy for Colorectal Cancer Screening," will use an entertainment education approach to promote informed decision making about CRCS among men and women with low health literacy, who are presenting for health care in urban community health centers. Entertainment education is the process of purposely designing and implementing media that incorporate educational messages in an entertaining format, and is a promising strategy for communicating health information to patients with low health literacy. The specific aims of this project are as follows: 1) Use a participatory research approach, representing the perspectives of consumers and providers of primary health care, to develop an entertaining computer-supported patient decision aid (PtDA) for decision-making about CRC screening;and 2) Conduct a feasibility pilot study of the PtDA intervention in community health centers serving a large, primary care population with low health literacy. The Edutainment Decision Aid Model (EDAM), a framework for linking learning theory and entertainment education, will be used to guide development of the PtDA. The EDAM uses two integrated components to promote user engagement-soap opera scenes and interactive learning modules-integrated elements that engage the user in an interesting story while providing essential information about the choices and tools for clarifying values in making a decision. Two tracks will be developed, one where the main character is African American and a second where the main character is an English-speaking Hispanic patient. The feasibility study will be conducted in a sample of 100 African American and 100 English-speaking Hispanic primary care patients who are candidates for CRCS and are patients at a community health center located in Houston, Texas. Strategies for implementing the PtDA in busy clinical settings, patients'acceptance of the intervention, and refinement of process and outcome measures will be addressed in the feasibility study. A subsequent randomized trial will be planned to evaluate the PtDA in multiple clinical settings against an aid with the same content but lacking the entertainment component. A Spanish language track will also be developed for the subsequent trial. Death from colorectal cancer is preventable if the cancer is detected early. Screening rates for colorectal cancer are well below targets set by Health People 2010, particularly among African American and Hispanic patients. Educational interventions which rely on entertainment to engage patients in the content have great promise for increasing motivation and rates of completing colorectal cancer screening test. PUBLIC HEALTH RELEVANCE: Death from colorectal cancer is preventable if the cancer is detected early. Screening rates for colorectal cancer are well below targets set by Health People 2010, particularly among African American and Hispanic patients. Educational interventions which rely on entertainment to engage patients in the content have great promise for increasing motivation and rates of completing colorectal cancer screening test.